Question:
Jst denied for Abdominoplasty need appeal letter

   — michaela (posted on October 9, 2003)

October 9, 2003
Look at the question below (#245 right now), titled in LARGE CAPITAL LETTERS "Here's how I got my reconstructive surgery approved" or something like it. If you follow this persons advice I don't see how you could lose on your appeal. This person has put ALL of the info you'd need to get reconstructive surgery approved on ALL body parts.
   — bufordslipstick

October 9, 2003
P.S If you don't get to read this in time before the question goes into the library, I feel you could pull the question up if you looked under the word "reconstructive".
   — bufordslipstick

October 9, 2003
I just won a panni w/abdominoplasty appeal today. Please e-mail me and I can send you the information I sent to my insurance company.
   — Stephanie B.

October 9, 2003
Before you use someone else's sample letter....know what your policy says. I used a sample letter and if I knew then what I know now, I would have composed something entirely different. My mistake on my first letter were many,1)didn't have medical necessary letters from doctors (got them for my 2nd appeal)2)Did not get offical diagnois of back pain and abdominal pain from my PCP and treatment other then wearing a binder. 3)Can not grow a rash now to save my neck and just said I was using OTC meds - big mistake - wasn't costing them any money. Was denied twice for reason not covered in policy - had an appeal hearing and that denial upheld first 2 except now they said I didn't prove medical necessary. What I received on 3rd denial was their medical necessary guidelines for abdominoplasty & pannilectomy. I request an external review (independent - IN law)and in my request I am claiming I was unfairly denied because I was denied 2x because they claimed not covered procedure but yet they have guidelines for medical necessary for this procedure. Study your policy and make sure you have your documentation before starting the approval process.
   — bbjnay